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Smaller financial bite lures dental patients to Mexico

THE BALTIMORE SUN

NUEVO PROGRESO, Mexico - The first time Roselyn Stensrud visited a "dentista" on the main drag in this tiny, border tourist town, he yanked a permanent crown out of her mouth without telling her and before she could yell stop.

"I had my mouth open and didn't know what he was doing," said Stensrud, 71, a thin, silver-haired bus driver from Arkansas who retired to South Texas a year ago. "He glued it back in, but it didn't hold."

Determined to get it fixed, she tried a different dental clinic a few steps away. Still unhappy with the work, she went to yet another across the street.

Stensrud, like thousands of American retirees in Texas, travels south of the border several times a year to try her luck in this six-block area crammed with about 100 dentists offering cut-rate care.

It's the quick service and bargain basement prices, not necessarily the quality of the work, that bring them to Nuevo Progreso - a town of cheap dentists and their flashy advertisements, mixed in with street vendors, beggars, restaurants, pharmacies, beauty salons and liquor shops.

Walk-ins are always welcome, evaluations are free and window advertisements scream: "We speak English! We have the office! We have the newest tec-nology on sterilization."

Price lists are plastered across front doors or handed out in colorful fliers: cleaning, $10; extraction, $15; root canal, $110; dentures, $120.

For many without dental insurance, it's worth the gamble.

They know they can get the work redone two or three times if necessary, and it will still be cheaper than going to a dentist in the United States.

Stensrud got seven teeth pulled, a root canal, a set of partial dentures and two sets of full dentures for $900. North of the border, that would run her a minimum of $5,000.

"I've never been afraid of the dentists here," Stensrud said as she waited for a second denture adjustment on her new teeth. "The same thing that happened to me here could happen in the States. You can't judge them all by just a few."

An estimated 800,000 people cross the almost 2,000-mile-long United States-Mexico border with ease every day for shopping, school, work, play or services such as dental care. Some say there is so much movement between the two countries that the border is virtually disappearing.

That offers consumers more options, but less assurance of quality and less recourse if something goes wrong.

"When you go over there, you should be aware you're on your own," said Jeffrey Hill, executive director of Texas' State Board of Dental Examiners. "I wouldn't do it because you don't have any way to find out about their qualifications and licenses. Here, at least you can find out if they're licensed."

Mexico's National Commission on Medical Arbitration asserts that it has received no complaints against dentists along the Mexican border within the past five years, according to its office of investigations.

People like Stensrud and many others who don't speak Spanish say they wouldn't know how to make a complaint if they had one.

The Mexican dentists survive almost exclusively on business from "winter Texans," a group of about 124,000 U.S. retirees, most of whom park their mobile homes in South Texas a few months a year. Despite dumping an estimated $329 million into the Rio Grande Valley each year, they have a reputation for being frugal spenders. The majority are from the Midwest.

In Nuevo Progreso, they simply call them "los winter" and appreciate them so much that the city holds a "Tourist Day" each March 21, complete with a parade, free food and music.

When "los winter" are not in town from May to September, dentists rely on business from retirees from the Rio Grande Valley and from younger families who cross the border for care.

To the dismay of South Texas dentists, the clients continue to pay a quarter and walk across a short bridge from Progreso, Texas, directly onto Avenida Juarez, the Mexican town's tourist strip.

They need not show so much as a passport or driver's license to cross the international bridge. People flow back and forth all day and night, while Mexican children stand below, begging Americans to drop their change.

Nuevo Progreso is one of several northern Mexico cities along the Rio Grande that are filled with dentists' and eye doctors' offices, cancer treatment centers and other such amenities that have become tourist attractions.

It was in 1997 that paralegal Mary Perez crossed the border to go to an orthodontist in Nuevo Progreso for braces based on the recommendation of a co-worker. Three years and $1,500 later, she realized her lips and gums had been swollen almost the whole time, and her mouth was in constant, nagging pain.

"I looked like I had boxer lips," said Perez, 30.

Last year, she went to a dentist in McAllen, Texas, who said her teeth were so loose they were in danger of falling out and she had severe bone loss. He took the braces off, and she started a process of gum surgery and antibiotics to kill the infections.

Expenses growing

For that, she spent $1,300 and still needs braces, which will cost her an additional $4,000.

She hasn't been back to her dentist in Mexico to tell him what happened, but she says she plans to write him a letter asking for her money back.

It won't work to sue him in U.S. courts because the work took place in Mexico, but she says she might sue him personally, because he, like many dentists in Nuevo Progreso, lives in Texas' Rio Grande Valley.

"I would never go back to another dentist in Mexico," she said. "I don't tell other people not to go, but I tell them of my experience."

The dentists' offices have had a presence in Nuevo Progreso for more than three decades, but recently have been multiplying so quickly that they're starting to stack on top of one another.

"You can make a hell of a lot of money over there," says James A. Person, who has had a general dentistry practice in the border town of McAllen for 23 years. "You have low overhead and no personal injury insurance."

Luis G. Guerrero, 37, opened his Medical Dental Center on Avenida Juarez two years ago, when there were already 85 dentists on the strip.

He moved his office north after 14 years in practice in central Mexico so he could be closer to the action. "It's a good business," he says.

Guerrero, who does not advertise, says 100 percent of his patients are from the United States, which is the rule in Nuevo Progreso.

"We're saturated," said Jesus Aguirre, 63, who is called the "Papa" of Nuevo Progreso because he has the oldest dental practice there. "The problem now is some of the dentists aren't ethical; they only think about tourism business."

Satisfaction or money back

Aguirre, who lives in South Texas but speaks no English, hires a translator to communicate with his patients. If they're not happy with his work, he says, he refunds their money, something not all dentists on the strip will do.

Since Aguirre started his clinic 37 years ago, he has had 15 dentists apprentice under him, then start their own practices on the avenida. After he and his wife divorced about 30 years ago, she started a rival practice on the street, as did their son and nephew.

Their son, Xavier Aguirre, earned his dental degree in Mexico, though he attended high school and college in Texas and now lives in the Rio Grande Valley. He says he doesn't want to practice in the United States.

"The overhead is drastically lower here," explains Aguirre, 31, who set up his shop 10 years ago. "I'm happy here - it's stress-free."

He advertises on his office window and in Texas newspapers that he is a "member" of the American Dental Association, though he's actually an affiliate member.

According to the ADA, foreign-trained dentists are not permitted full membership. Aguirre calls the difference "semantics." And he calls his advertisement claiming "certified in cosmetic dentistry" a "play on words" because, he admits, no such certification exists.

According to the Dental Association of Nuevo Progreso, there are about 100 dentists housed in 48 offices on the northernmost six blocks of the town.

Just under half of the dentists belong to the association, which was formed about a year ago. The rest belong to no formalized dental association.

Unlike American dentists, Mexican dentists are not required to belong to a professional association once they begin to practice.

The Mexican Dental Association (ADM), based in Mexico City, counts 4,000 members of an estimated 18,000 practicing dentists in the country.

There is a push to register all dentists with the ADM, said Maria Dolores Gurrea, an ADM secretary, but it hasn't been very successful.

Person, who specializes in restorative dentistry, says that once or twice a month, he'll see patients who had unsatisfactory work done in Mexico and want him to fix it.

"We have no control over these people. I don't want to offend anybody, but their education is inferior," said Person. "There will be exceptions; some dentists over there are good. But I can guarantee 50 percent of dentists on that strip in Progreso are not what I'd consider quality dentists."

Difference in education

Mexican dentists are not required to go to an undergraduate university. They instead enroll in one of the country's 40 dental schools after high school. The courses take four or five years, depending on the program.

But as long as the care is satisfactory and cheap, the patients are happy.

"Oh, they're real good," said Betty Montano, 65, who lives near Corpus Christi and drives four hours each way with her husband every few months to visit dentist Veronica Munoz. "I guess you could say they cater to the Americans. You can tell they try real hard."

The Montanos believe they save at least $1,000 a trip and are thrilled with the service they're receiving.

Munoz, 29, who has been practicing in Nuevo Progreso for four years, said she likes working with the elderly from across the border.

"Most people here are old, and they come in with diseases like cancer and leukemia. Some of them don't have dental insurance, and I know this is a lot cheaper for them," said Munoz. "We like to do something good for them."

John Gerling, an orthodontist who practices in McAllen, says the Mexican dentists might have good intentions but often do bad work. About once a month, a patient will come to him with problems such as sloppy brackets on his teeth held on with excess glue. Most have gotten the work done in Mexico.

"Price is a one-time consideration," he said. "Cost is a continuing consideration."

But for Stensrud, who has no dental insurance and lives in an adult trailer park in a small South Texas town, the price of getting even simple dental work in the United States can be prohibitive.

"At this age, what am I going to do?" she asks.

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